Worcester pharmacy must repay state $1.6M over automatic refills

Friday

Sep 6, 2013 at 1:42 PMSep 6, 2013 at 1:48 PM

By Shaun Sutner, TELEGRAM & GAZETTE STAFF

BOSTON — A Worcester pharmacy that manages medication programs for people with chronic illnesses such as AIDS and Hepatitis C has agreed to pay the state back $1.6 million for allegedly over-billing the state's Medicaid program, Attorney General Martha Coakely said Friday.

Under the terms of the settlement with the Ms. Coakley's office, AllCare Pharmacy will also be subject to additional reporting requirements to ensure compliance in the future, according to the AG's office.

Allcare, which is based at 12 Plymouth St., received payments from MassHealth, the state Medicaid program, when it automatically refilled prescriptions that were not specifically requested by MassHealth patients, the AG said.

The agreement is the first case in the state to focus on a pharmacy's operation of an improper automatic refill program for MassHealth members, according to a news release from Ms. Coakley's office.

MassHealth officials first referred problems with the pharmacy to the AG's office in March 2011.

The AG's investigation found that AllCare from October 2008 to July 2012 used an automatic refill program in direct violation of MassHealth regulations.

The state insurance program's rules prevent any pharmacy in the state from refilling prescriptions not explicitly requested by MassHealth patients or caregivers.